CDC Issues Sepsis Care Guidance for Hospitals

The CDC issued new guidance to hospitals Thursday for managing sepsis and called on hospitals to do better at treating it.

"Every hospital, regardless of size, location, and resources can strengthen the quality of care delivered to these patients and ensure their survival," CDC Director Mandy Cohen, MD, MPH, said at a press conference. "That's why CDC developed the Hospital Sepsis Program Core Elements to put providers in the best position possible to deliver effective care for patients with sepsis."

The seven core elements of the program include:

• Leadership. "Sepsis programs require the necessary human, financial, and information technology resources to be successful," said Raymund Dantes, MD, MPH, CDC medical advisor and co-developer of the core elements.
• Accountability. "It's important for sepsis programs to appoint a leader responsible for the program outcomes and to set concrete program goals," he said.
• Multi-professional expertise. "Sepsis care spans the continuum of hospitalization and requires coordination of many services and disciplines," Dantes said. "It is critical to engage those key partners throughout the organization such as the emergency department, the intensive care units, wards, physicians and nurses, specialists, and those caring for distinct populations such as pediatrics or labor and delivery."
• Action. This element "describes how to implement structures and processes to improve the identification of, management of, and recovery from sepsis," he continued. "These recommendations complement clinical guidelines for early recognition and early management, and provide additional guidance for supporting patients recovering from sepsis."
• Tracking. This element "provides a guide for measuring sepsis progress towards program goals and the impact of sepsis initiatives," Dantes said.
• Reporting. This element "describes how to provide usable feedback on sepsis care to healthcare providers and usable data to relevant partners," he said.
• Education. This element includes resources for providing ongoing sepsis education to healthcare professionals, Dantes said.

"In a typical year, 1.7 million adults in America develop sepsis, and at least 350,000 adults unfortunately die during hospitalizations or are moved into hospice care," Cohen said, noting that her own mother had developed sepsis nearly 20 years ago and was saved by "the incredible medical team at the hospital that responded to her emergency." Officials at the press conference were unable to provide details about the overall cost of sepsis care.

"The care of patients with sepsis is complex and as a physician who has cared for those patients, it requires rapid coordination between multiple hospital departments and disciplines to respond and then manage the recovery of the patient," Cohen added. "We know that programs dedicated to the care of patients with sepsis have been successful in saving more lives, reducing the amount of time patients need to stay in the hospital, and cutting healthcare costs."

A 2022 CDC survey of 5,122 U.S. hospitals found that 73% of hospitals had a sepsis team, but only about 55% of those team leaders are provided with dedicated time to manage those sepsis programs, Cohen said. "And only about half of the hospitals reported that their teams integrated their antibiotic stewardship experts into their sepsis programs. So more work to do here."

At the press conference, reporters also heard from Alice Tapper, daughter of journalist Jake Tapper, about her experience with sepsis. In November 2021, she was taken to the hospital with severe abdominal pain and a 102° fever. "I had a rapid pulse of 135 and a very high white blood cell count of 20,000," she said. "They offered me fluids but could not figure out what was wrong with me." She was transferred to another hospital and diagnosed with severe gastroenteritis and was told her condition would resolve on its own.

Over the next 32 hours, her symptoms worsened. Finally, "I got an x-ray that led to a sonogram and surgery," she continued. "I had a perforated [appendix] and a CT scan showed I had fluid leaking throughout my abdomen. I was rushed to the ICU. I was septic and the appendix was too inflamed to be removed and my body was in hypovolemic shock." She had several additional surgical procedures, including eventual removal of the appendix "and a long procedure to repair my bowels."

Tapper said she wanted to encourage hospitals to listen to patients. "If appendicitis had been taken seriously, and the signs and symptoms of sepsis had been acknowledged, my course of care would not have resulted in weeks in the hospital and a long recovery at home," she said.

One problem with sepsis is that the symptoms are not the same in every patient, said Chris DeRienzo, MD, chief physician executive at the American Hospital Association. "Sepsis isn't just one disease, and in my specialty population -- sick and extremely premature newborns -- the early warning signs of sepsis can look wildly different than those of trauma patients coming out of surgery, or of elderly patients in a nursing home," he said. "This is why it is crucial to have leadership commitment to supporting the early identification and early treatment programs needed in hospitals."

Asked by MedPage Today about cost concerns for hospitals wanting to implement the core elements, DeRienzo noted that 2022 "was the worst operating year on record for the entire universe of hospitals in America, so the financial strain is real ... and it doesn't get easier when you talk about the kinds of [reimbursement] denials -- even relative to sepsis care -- that we face from some insurance companies." Despite that problem, however, DeRienzo said he had seen firsthand hospitals commit to improving sepsis care at one health system for which he had worked.

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